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Sir:

We read with great interest the article on the classification of vascular anomalies and the comprehensive treatment of hemangiomas.1 We are all too aware of the difficulties of treating hemangiomas, such as the timing and duration of intervention, and the inadequacy of conventional therapies.

The article clearly demonstrates the side effects of the pharmacologic treatments for hemangiomas and the need for newer treatment options. Recently, a number of cases have been reported of the efficacy of β-blockers in the treatment of hemangioma.2,3

As part of a larger study, we have used propranolol in a total of 15 patients. So far, we have observed signs of rapid involution of hemangioma within the first week of treatment in all patients (Fig. 1). The response rate is faster than those we have seen when corticosteroids are used. In addition to stopping the proliferation of hemangiomas, propranolol also causes rapid involution within a short period. We now offer propranolol as a first-line treatment to all rapidly proliferating hemangiomas with functional deficit and/or disfigurement. We have developed a treatment protocol in conjunction with the cardiologist that involves pretreatment cardiac workup and an in-hospital titration of propranolol up to 1 mg/kg three times per day.4 So far, we have not needed to increase the dosage to more than 1 mg/kg three times per day.

All patients have responded well to treatment, with no side effects. Although we agree with all the points raised in the thorough article by Burns et al., we would like to suggest that β-blocking agents have an important role in the management of infantile hemangioma.

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David H. Song, M.D., M.B.A. is the President-elect of the American Society of Plastic Surgeons (ASPS). He is a consultant with BioMet, Emmi Solutions, LLC, a consortium-member providing senior debt for Brava, and consultant with and investor in HealthEngine.com. He receives author royalties from Elsevier. Scot Glasberg, M.D. is the President of the American Society of Plastic Surgeons (ASPS). He is a consultant with LifeCell Corp and Mentor Corp and an investor with Strathspey Crown. The authors have no sources of funding to report related to the writing or submission of this discussion.

The location and affiliation information should read as follows: Arlington Heights, Ill. From the American Society of Plastic Surgeons/Plastic Surgery Foundation.